Shared decision-making is a process in which clinicians and patients work together to select tests, treatments, management or support packages, based on clinical evidence and the patient’s informed preferences. It involves the provision of evidence-based information about options, outcomes and uncertainties, together with decision support counselling and a system for recording and implementing patients’ informed preferences.
The government wants shared decision-making to become the norm in the NHS, but there is confusion about why it is important, what it involves and what the implications might be for patients, clinicians and the wider health service. This report clarifies the concept and outlines the actions needed to make the aspiration a reality.
The report concludes:
The key message is that we could do better and we need to do better. Effective shared decision-making is not yet the norm and many patients want more information and involvement in decisions about treatment, care or support than they currently experience.
The biggest challenge now is to devise effective ways for supporting shared decision-making and ensuring it is embedded in mainstream clinical practice. Embedding shared decision-making into systems, processes and workforce attitudes, skills and behaviours is a challenge, but several pilot implementation projects are under way and they will offer valuable experience on which to base practice in the future.
It is important that the lessons about how to design systems of care that promote shared decision-making from these demonstration projects are captured and used to inform future policy and practice. It is likely that embedding shared decision-making will require a combination of effective clinical leadership, social marketing, incentives, practical support, education and training, measurement and feedback, and patient push.
Angela Coulter, Alf Collins. Making shared decision-making a reality: no decision about me, without me (PDF). The King’s Fund, July 2011.